BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

s SAN JOAQUIN COUNTY -ENVIRONMENTAL HEALTH DEPARTMENT ', ' 600 East Main Street, Stockton, CA 95202-3029 Telephone:(209) 468-3420 Fax: (209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM�STORAGE-PROGRAM SURVEY FORM Facility Name: R � o OuT A A-R fV-7,S- Page —j—of Facility Address: City: Inspection Date: FA#: PR#: Program Element: Z7 gel Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 2:1,320 gallons in tanks* and containers**. Complete-one box for each tank or each cumulative container product type. ank (2820) ❑ Containers (2821) #of Containers: TA#: 1 Product Type: _ T" I� Total Capacity: fa G) gallons (per tank or cumulative for containers by product type) °l nstall Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 2 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) -Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: E 4 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: J— gallons Total Capacity for Site: gallons Comments: T �'-,n GOL t EHD Inspector: Reviewed Date: Entered Date: By Initial: 1 �`� '6, By Initial: )/T �� *Aboveground storage tank means a tank that has the capacity to store 55 gallons or more o petroleum. v **Container means a storage device designed to be moved when full. _ 1HD 28.01 AST SURVEY FORM \ t' .09112/08